Impact of point-of-care pre-procedure creatinine and eGFR testing in patients with ST segment elevation myocardial infarction undergoing primary PCI: The pilot STATCREAT study

• Published in: International journal of cardiology Vol. 240; pp. 8 - 13
• Main Authors: Karamasis, Grigoris V., Hampton-Till, James, Al-Janabi, Firas, Mohdnazri, Shah, Parker, Michael, Ioannou, Adam, Jagathesan, Rohan, Kabir, Alagmir, Sayer, Jeremy W., Robinson, Nicholas M., Aggarwal, Rajesh K., Clesham, Gerald J., Gamma, Reto A., Kelly, Paul A., Tang, Kare H., Davies, John R., Keeble, Thomas
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.08.2017
• Subjects: Acute Kidney Injury - blood; Acute Kidney Injury - diagnosis; Acute Kidney Injury - etiology; Aged; Cardiovascular; Cohort Studies; Contrast-induced AKI; Creatinine - blood; Early Medical Intervention - methods; Female; Glomerular Filtration Rate - physiology; Humans; Male; Middle Aged; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - methods; Pilot Projects; Point-of-Care Systems; Point-of-care testing; Primary PCI; Prospective Studies; Retrospective Studies; ST Elevation Myocardial Infarction - blood; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - surgery; STEMI; STEMI; Point-of-care testing; Contrast-induced AKI; Primary PCI
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2017.03.147

Contrast-induced acute kidney injury (CI-AKI) is a recognised complication during primary PCI that affects short and long term prognosis. The aim of this study was to assess the impact of point-of-care (POC) pre-PPCI creatinine and eGFR testing in STEMI patients. 160 STEMI patients (STATCREAT group) with pre-procedure POC testing of Cr and eGFR were compared with 294 consecutive retrospective STEMI patients (control group). Patients were further divided into subjects with or without pre-existing CKD. The incidence of CI-AKI in the whole population was 14.5% and not different between the two overall groups. For patients with pre-procedure CKD, contrast dose was significantly reduced in the STATCREAT group (124.6ml vs. 152.3ml, p=0.015). The incidence of CI-AKI was 5.9% (n=2) in the STATCREAT group compared with 17.9% (n=10) in the control group (p=0.12). There was no difference in the number of lesions treated (1.118 vs. 1.196, p=0.643) or stents used (1.176 vs. 1.250, p=0.78). For non-CKD patients, there was no significant difference in contrast dose (172.4ml vs. 158.4ml, p=0.067), CI-AKI incidence (16.7% vs. 13.4%, p=0.4), treated lesions (1.167 vs. 1.164, p=1.0) or stents used (1.214 vs. 1.168, p=0.611) between the two groups. Pre-PPCI point-of-care renal function testing did not reduce the incidence of CI-AKI in the overall group of STEMI patients. In patients with CKD, contrast dose was significantly reduced, but a numerical reduction in CI-AKI was not found to be statistically significant. No significant differences were found in the non-CKD group.